Viewing Decentralization as an Opportunity: In Improving Availability of Health Workers in Underserved Areas

Abstract
Providing health care to underserved communities in Indonesia has long been a major concern. Lack of health workers particularly in rural remote and very remote areas has hampered community access to good quality of health services, which in turn leads to a poor health status of the people.
Implementation of the decentralization policy in health has affected human resources for health. Employment of health workers in public facilities has been transferred to the responsibility of the local government, especially at the district level. To some districts with shortage of certain type of health professional, difficulties in recruiting health workers have been answered through opening of new health workforce education institutions, provision of scholarship, and provision of financial incentives in return to serve in the underserved areas for certain period. However, disparity in financial capacity and geographical condition among districts creates favorable and non favorable areas to health workers.
Another consequence of this decentralization policy is the break-down of health personnel information system as the local level thinks there is no more obligations in sending data to the upper level.
This paper aims to assess the impacts of decentralization policy in Indonesia and what opportunities can be taken by each government level to improve the health workforce situation particularly in underserved areas. A desk study was performed from relevant published materials. Literature was reviewed from databases of the Ministry of Health. A clear understanding of the implementation of this policy and its impact is critical to face tomorrow challenges to improve health workforce distribution in the underserved areas.

Keywords: underserved area, decentralization, health worker
1Anna Kurniati, 2Ferry Efendi
1Center of Planning and Management of Human Resources for Health
Ministry of Health, The Republic of Indonesia
Jl. Hang Jebat Raya F3, Kebayoran Baru Jakarta, 12120
2Faculty of Nursing Airlangga University Indonesia
Jl. Mulyorejo Kampus C Unair Surabaya 60115

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